Link cost row A to procedure row B

[vojtechhuser]

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Related forum post: https://forums.ohdsi.org/t/linking-cost-to-other-tables/21781/11

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[jenniferduryea]

This ticket specifically references the convention for linking a cost row to a procedure row.
_Please note that this logic also applies to prescription claims where the NDC code billed should be referenced to the line item payment associated. Hence the cost row A should be li_nked to the drug_exposure row B.

Background: In US claims data, professional claims (HCFA 1500 or 837P claims) are paid by CPT/HCPCS code billed. Each CPT/HCPCS is paid at a rate referenced on a fee schedule agreed by both the professional provider (i.e. doctor, nurse practioner, laboratory, physical therapist, etc.) and the payer. When datasets provide line item payments, the payments from professional claims should be referenced to the cpt/hcpcs billed on that claim. In the US, facility claims (UB04 or 837I claims) are paid by revenue code. When revenue codes are associated to CPT/HCPCS codes billed (as in outpatient facility claims), the payment is associated with the revenue code AND CPT/HCPCS code billed. As with professional claims, facility claims that have line item payments should be associated with the CPT/HCPCS code billed (along with the associated revenue code).

Use case: Determine the cost information for certain procedures. Since most CPT/HCPCS codes are defined as procedures in current OHDSI vocabularies, there is a need to link associated costs to procedures to maintain the relationship between cost and billed CPT/HCPCS codes. This linkage will support HEOR questions such as "how much does this procedure cost the patient and/or payer?".

Implementation: the following fields should be filled out for linking cost row A with procedure row B

1. cost_id = unique id field that identifies that cost row A. Similar to the other id fields used in event tables (i.e. condition_occurrence_id, drug_exposure_id, etc.)
2. cost_event_id = the procedure_occurrence_id value that links the associated cpt/hcpcs event to the cost
3. cost_domain_id = the table the cost_event_id is referring too. In this case, it's the procedure_occurrence table.
4. revenue_code_concept_id = the revenue code associated with the cost. See the description of outpatient facility cost reimbursement procedures in this Background section.

When finding costs associated with a procedure, you would find all matching cost records with a cost_domain_id = "procedure_occurrence" and a cost_event_id = procedure_occurrence_id of desired procedure_occurrence records.